Analysis of antibiotic use and access to drugs among poultry farmers in Kenya.

Understanding access to and use of antibiotics in livestock production systems is critical for guiding antimicrobial stewardship programmes and animal health services. We analysed antibiotic use practices among smallholder-intensive poultry farms in Kenya and characterised access to veterinary supply chains by calculating travel time to drug stores. Data were collected from 766 poultry farms across 15 Kenyan counties, representing all production types, between May 2021 and February 2022. We also collected antibiotic sales and geolocation data from 321 veterinary drug stores in Nakuru and Kilifi counties, representing areas with high and low-intensity poultry production, respectively. Using a machine learning framework, we predicted farm-level antibiotic use based on collected demographic and production traits. We also built geospatial models to characterise farmer travel time to drug stores with motorised transport. Half of farms used antibiotics at least once in the last two months, mostly for self-administered therapeutic reasons. Random forest analysis predicted that farms using disinfectants in cleaning, keeping other poultry species, with rodents in the chicken house and vaccinating their birds had the highest likelihood of antibiotic use. 95.4 % of farmers lived within one hour of a veterinary drug store, with 40 % residing within 15 min. Antibiotic use is integrated in smallholder poultry production, emphasising the need for prioritizing biosecurity, regulatory and socio-behavioural interventions, and economic incentives to enhance stewardship. Spatial maps suggests both risks and opportunities for antibiotic access and veterinary care.